| NPI | 1679732648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 86555) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 8406) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2023-01-03 |