| NPI | 1033240080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS21132) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 21132) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2019-02-13 |