| NPI | 1467968909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW89415) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC P010456) |
| Enumeration Date | 2017-12-20 |
| Last Update Date | 2019-08-14 |