| NPI | 1295180032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 29637) |
| Additional Taxonomies | 284300000X Special Hospital (Licence: CA 29637) |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2016-04-29 |