| NPI | 1942677349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 83610) |
| Additional Taxonomies | 174400000X Specialist |
| 104100000X Social Worker | |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2024-10-15 |