| NPI | 1659387504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 27011) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW 17743) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2019-04-09 |