| NPI | 1356877872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 75591) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 120383) |
| Enumeration Date | 2017-05-03 |
| Last Update Date | 2020-11-09 |