| NPI | 1104905736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 79091) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 114777) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2018-03-29 |