| NPI | 1023127941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 29817) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PA CW013466) |
| 1041C0700X Social Worker Clinical (Licence: CA LCSW29817) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2024-08-22 |