| NPI | 1891827606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW24415) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW15884) |
| 1041C0700X Social Worker, Clinical (Licence: CA LCS24415) | |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2021-12-14 |