| NPI | 1053823260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 109848) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09929487) |
| Enumeration Date | 2017-10-27 |
| Last Update Date | 2026-06-18 |