| NPI | 1194379131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSB94028650) |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2025-09-29 |