| NPI | 1679354476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA LCSW122816) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ACSW98323) |
| 104100000X Social Worker (Licence: CA LCSW122816) | |
| Enumeration Date | 2023-10-09 |
| Last Update Date | 2024-06-10 |