| NPI | 1861491292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS 24859) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 068678-1) |
| 1041C0700X Social Worker, Clinical (Licence: WA LW00004243) | |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2011-03-18 |