| NPI | 1376639740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW73330) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I0007611) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2018-02-08 |