| NPI | 1205452679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW121041) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 103970) |
| Enumeration Date | 2020-06-22 |
| Last Update Date | 2024-07-01 |