NPI | 1164940615 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 99905) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW84565) |
Enumeration Date | 2017-09-05 |
Last Update Date | 2024-11-07 |