| NPI | 1902936404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 26446) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 20633) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2018-05-14 |