| NPI | 1528110624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 25477) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 25477) |
| 104100000X Social Worker (Licence: CA LCS 25477) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2021-03-17 |