| NPI | 1164940615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 99905) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA ASW84565) |
| Enumeration Date | 2017-09-05 |
| Last Update Date | 2024-11-07 |