| NPI | 1346968708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 129290) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 111301) |
| Enumeration Date | 2022-08-19 |
| Last Update Date | 2025-05-22 |