| NPI | 1477910990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 74341) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 77306) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2023-04-11 |