| NPI | 1194191395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 91322) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 91322) |
| Enumeration Date | 2015-08-11 |
| Last Update Date | 2023-06-01 |