| NPI | 1659788180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 34999) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: AL LICSW3984C) |
| 1041C0700X Social Worker, Clinical (Licence: CA LCSW76682) | |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2018-09-26 |