| NPI | 1255678470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 73899) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904008091) |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2016-11-29 |