| NPI | 1770709909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 74812) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 111884) |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2023-09-25 |