| NPI | 1114093119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L4756) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 20539) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2017-03-13 |