| NPI | 1790924033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 88307) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 60924) |
| Enumeration Date | 2009-02-10 |
| Last Update Date | 2024-06-03 |