| NPI | 1003069675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904006961) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS22881) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2024-06-20 |