| NPI | 1700161346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 65306) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: HI 4675) |
| Enumeration Date | 2011-10-14 |
| Last Update Date | 2021-07-06 |