| NPI | 1427219484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 71560) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 33642) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2016-07-18 |