| NPI | 1255511770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 36469) |
| Additional Taxonomies | 174400000X Specialist |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2015-07-17 |