| NPI | 1730745035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: CA LCSW120752) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW120752) |
| Enumeration Date | 2019-05-13 |
| Last Update Date | 2024-02-12 |