| NPI | 1073948766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW82392) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: CA ASW67689) | |
| Enumeration Date | 2013-09-12 |
| Last Update Date | 2024-06-10 |