| NPI | 1073639431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW27029) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW 20088) |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2018-10-15 |