| NPI | 1750380143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS14126) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2015-06-19 |