| NPI | 1306927926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 25769) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 14881) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2021-11-29 |