| NPI | 1215685920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 122634) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 102954) |
| Enumeration Date | 2022-03-11 |
| Last Update Date | 2024-08-09 |