| NPI | 1356529846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 25637) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L3237) |
| Enumeration Date | 2008-02-06 |
| Last Update Date | 2015-09-24 |