| NPI | 1194248476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW90093) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW36425) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2022-07-21 |