| NPI | 1083127583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L15075) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LSCW95731) |
| Enumeration Date | 2017-11-07 |
| Last Update Date | 2025-03-10 |