| NPI | 1649478736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA LCSW62672) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA LCSW 62672) |
| 1041C0700X Social Worker Clinical (Licence: CA 62672) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2016-12-06 |