| NPI | 1922143817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW 75147) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 65143) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2017-01-15 |