| NPI | 1760951529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW103618) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW36810) |
| 104100000X Social Worker (Licence: CA ASW90429) | |
| Enumeration Date | 2018-11-21 |
| Last Update Date | 2021-10-01 |