| NPI | 1194093682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW65309) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2011-12-12 |
| Last Update Date | 2015-06-11 |