| NPI | 1215017009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 26960) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS 19143) |
| 1041C0700X Social Worker, Clinical (Licence: NV 5980-C) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2021-12-14 |