| NPI | 1306007646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW28593) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 28593) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2026-09-24 |