| NPI | 1467962555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW95780) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 78309) |
| 104100000X Social Worker (Licence: CA LCSW95780) | |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2023-07-11 |