| NPI | 1124272273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW95427) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 95427) |
| 1041S0200X Social Worker School (Licence: CA ASW72994) | |
| 171M00000X Case Manager/Care Coordinator (Licence: N/A) | |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2025-03-12 |