| NPI | 1447472253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 25865) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC c004748) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2010-06-11 |