| NPI | 1053549840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 109043) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 109043) |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2025-07-23 |