| NPI | 1225212269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 28633) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 18855) |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2021-04-19 |