| NPI | 1215290069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 28894) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904007884) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2015-02-09 |