| NPI | 1093443590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 137874) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AZ LMSW-20066) |
| 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-22245) | |
| Enumeration Date | 2022-08-11 |
| Last Update Date | 2026-04-24 |