| NPI | 1164966719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW93041) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW73714) |
| Enumeration Date | 2016-12-15 |
| Last Update Date | 2021-06-09 |