| NPI | 1598230583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 102453) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 84895) |
| Enumeration Date | 2018-10-05 |
| Last Update Date | 2021-09-03 |