NPI | 1164966719 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW93041) |
Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW73714) |
Enumeration Date | 2016-12-15 |
Last Update Date | 2021-06-09 |