NPI | 1134299027 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS20950) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA 20950) |
Enumeration Date | 2006-11-08 |
Last Update Date | 2007-07-08 |