| NPI | 1326652025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW129015) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW106962) |
| Enumeration Date | 2020-09-01 |
| Last Update Date | 2025-03-17 |