| NPI | 1538559760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW88280) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW61129) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2019-04-03 |