| NPI | 1891978870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW66054) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 1041C0700X Social Worker, Clinical (Licence: UT 7684422-3501) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 36882) | |
| Enumeration Date | 2007-12-12 |
| Last Update Date | 2015-05-12 |