| NPI | 1164800538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 85734) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 118973) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2018-09-27 |