| NPI | 1700239803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW86140) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 70706) |
| Enumeration Date | 2016-07-13 |
| Last Update Date | 2019-08-22 |