| NPI | 1336104629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 24364) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 2844213501) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2008-01-09 |