| NPI | 1528376514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 82755) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 32452) |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2021-02-08 |