| NPI | 1912022435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW119120) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09926690) |
| 1041C0700X Social Worker, Clinical (Licence: NM C-10346) | |
| Enumeration Date | 2007-03-21 |
| Last Update Date | 2024-01-04 |