| NPI | 1316634223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW123623) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 12525517-3501) |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW.09929171) | |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2024-08-02 |