| NPI | 1770058851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW108992) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L14016) |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2023-05-04 |