| NPI | 1366594871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS28454) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 137036-3501) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801079748) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2014-10-29 |