NPI | 1922143817 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW 75147) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 65143) |
Enumeration Date | 2007-02-20 |
Last Update Date | 2017-01-15 |