| NPI | 1093956658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 67603) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 25491) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2019-09-12 |