| NPI | 1538152467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW112491) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C004936) |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2023-02-24 |