| NPI | 1700275625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW82566) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA asw59508) |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2021-03-10 |