| NPI | 1124369053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW80510) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW 34747) |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2021-10-14 |