| NPI | 1003167230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW80082) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW62302) |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2018-02-16 |