| NPI | 1104275734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 118550) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 14220705-3501) |
| Enumeration Date | 2016-06-04 |
| Last Update Date | 2025-07-20 |