| NPI | 1235542861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW76907) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA asw63639) |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2021-03-16 |