| NPI | 1063688430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW62658) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW 25845) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2015-01-31 |