| NPI | 1598960361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW29857) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW 22176) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2015-11-25 |