| NPI | 1790739803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 29400) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA CW008896L) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2013-06-13 |