| NPI | 1154896785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW106350) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW90517) |
| Enumeration Date | 2018-10-10 |
| Last Update Date | 2024-01-30 |