| NPI | 1386817047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA LCSW70112) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW70112) |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2025-06-30 |