NPI | 1336218718 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS22129) |
Additional Taxonomies | 103T00000X Psychologist (Licence: CA 22129) |
Enumeration Date | 2006-11-07 |
Last Update Date | 2007-07-08 |