| NPI | 1154668218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW81074) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 60275) |
| Enumeration Date | 2013-01-09 |
| Last Update Date | 2020-02-07 |