| NPI | 1982097333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 131832) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: CA 131832) |
| Enumeration Date | 2015-03-10 |
| Last Update Date | 2025-09-23 |