| NPI | 1578809463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 27804) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO 2012015566) |
| Enumeration Date | 2012-12-20 |
| Last Update Date | 2017-01-27 |