| NPI | 1144732470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW114075) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 77369) |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2023-03-14 |