| NPI | 1174831044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 73566) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW34446) |
| 104100000X Social Worker | |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2021-06-02 |