| NPI | 1477995249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW70491) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW09924003) |
| Enumeration Date | 2013-07-22 |
| Last Update Date | 2023-05-26 |