| NPI | 1790402956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker, School |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical (Licence: CA 93694) | |
| Enumeration Date | 2022-10-27 |
| Last Update Date | 2022-10-27 |