| NPI | 1902130115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 70052) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 246XC2901X Spec/Tech, Cardiovascular, Cardiovascular Invasive Specialist | |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2020-12-07 |