| NPI | 1306220421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW91416) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AZ LCSW-16584) |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2024-07-22 |