| NPI | 1730673450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW94074) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW36551) |
| Enumeration Date | 2018-06-16 |
| Last Update Date | 2021-05-10 |