| NPI | 1215453279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 119697) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2017-08-21 |
| Last Update Date | 2025-05-09 |