| NPI | 1265564330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW 25536) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW24979) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2012-03-01 |