| NPI | 1992024269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 71085) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 28058) |
| Enumeration Date | 2010-05-25 |
| Last Update Date | 2019-10-14 |