| NPI | 1487266185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW126299) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW107221) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2024-11-05 |