| NPI | 1093404485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 136529) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA 136529) |
| Enumeration Date | 2023-05-02 |
| Last Update Date | 2026-01-26 |