| NPI | 1942677349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 83610) |
| Additional Taxonomies | 104100000X Social Worker |
| 174400000X Specialist | |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2020-07-15 |