| NPI | 1134591415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW88983) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW68504) |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2021-09-22 |