| NPI | 1801914460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA LCS24562) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA ASW 12139) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2009-11-10 |