| NPI | 1164464442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 81140) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L3438) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2018-10-01 |