| NPI | 1447540497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904007624) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 122497) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2024-05-29 |