| NPI | 1386073765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW33376) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 104155) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2022-02-02 |