| NPI | 1023889862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 111278) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY P125473) |
| Enumeration Date | 2024-01-10 |
| Last Update Date | 2026-09-03 |