| NPI | 1356933196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW100467) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW135209) |
| 104100000X Social Worker (Licence: CA ASW76728) | |
| 1041C0700X Social Worker Clinical (Licence: CA ASW76728) | |
| 1041S0200X Social Worker School (Licence: CA LCSW100467) | |
| 175T00000X Peer Specialist (Licence: CA MPSS-JGDBCA) | |
| Enumeration Date | 2021-02-03 |
| Last Update Date | 2023-03-21 |