| NPI | 1487779096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 126159) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS23743) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2023-05-18 |