| NPI | 1912256918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW79656) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 62496) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2019-05-30 |