| NPI | 1508210147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW87524) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C009930) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2025-08-28 |