| NPI | 1104712173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW130626) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW130626) |
| Enumeration Date | 2025-06-16 |
| Last Update Date | 2025-12-15 |