| NPI | 1063066439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 104088) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 104088) |
| 1041S0200X Social Worker, School (Licence: CA 104088) | |
| Enumeration Date | 2019-07-24 |
| Last Update Date | 2024-11-12 |