| NPI | 1558597484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 75158) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 75158) |
| Enumeration Date | 2009-06-05 |
| Last Update Date | 2023-12-14 |