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 |