| NPI | 1205435815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 64757) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 64757) |
| Enumeration Date | 2020-10-23 |
| Last Update Date | 2020-10-26 |