| NPI | 1487048070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 93830) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW65434) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2020-01-24 |