| NPI | 1649683723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 95620) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW67877) |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2024-05-23 |