| NPI | 1760610232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW64300) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW26111) |
| Enumeration Date | 2009-06-23 |
| Last Update Date | 2015-01-12 |