| NPI | 1871741553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 91751) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 89427) |
| Enumeration Date | 2008-09-05 |
| Last Update Date | 2019-09-20 |