| NPI | 1811125255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 83070) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW66993) |
| Enumeration Date | 2009-06-24 |
| Last Update Date | 2018-06-04 |