| NPI | 1376049890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 180456) |
| Additional Taxonomies | 104100000X Social Worker (Licence: SC 12414) |
| 104100000X Social Worker (Licence: NM x-10412) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2020-10-09 |