| NPI | 1710314455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 74495) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW59847) |
| 104100000X Social Worker (Licence: HI LSW-2277) | |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2019-02-07 |