| NPI | 1174876304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 79187) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 60774) |
| 1041S0200X Social Worker, School (Licence: CA 79187) | |
| Enumeration Date | 2012-10-25 |
| Last Update Date | 2024-01-12 |