| NPI | 1144666744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW108940) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 97293) |
| Enumeration Date | 2013-05-22 |
| Last Update Date | 2022-08-10 |