| NPI | 1750776647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 84366) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW64506) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2019-08-20 |