| NPI | 1821499948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 107415) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 70685) |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2024-08-29 |