| NPI | 1093070260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 77313) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW020522) |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2022-06-22 |