| NPI | 1518368331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW87293) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OR L6320) |
| 1041C0700X Social Worker, Clinical (Licence: OR L6320) | |
| Enumeration Date | 2014-09-11 |
| Last Update Date | 2020-01-22 |