| NPI | 1255768867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS19977) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 19977) |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2022-03-07 |