| NPI | 1063006229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 126611) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 99753) |
| Enumeration Date | 2021-02-26 |
| Last Update Date | 2026-06-10 |