| NPI | 1265713796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6841) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 68700) |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2016-01-26 |