| NPI | 1174141055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW136266) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 93508) |
| Enumeration Date | 2020-07-08 |
| Last Update Date | 2026-09-02 |