| NPI | 1366981458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 100200) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09926473) |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2026-07-23 |