| NPI | 1689884892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR 3580) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS 10264) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2007-07-08 |