| NPI | 1154462752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 28340) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker Clinical (Licence: CA 22057) | |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2012-08-23 |