| NPI | 1326479502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW78675) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 34901) |
| Enumeration Date | 2013-12-12 |
| Last Update Date | 2021-11-15 |