| NPI | 1770615395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 20226) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NV 6067-C) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2022-07-21 |