| NPI | 1467994418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW90193) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW74385) |
| Enumeration Date | 2016-11-08 |
| Last Update Date | 2019-09-03 |