| NPI | 1386391738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 129378) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: 105183) |
| Enumeration Date | 2022-03-06 |
| Last Update Date | 2025-04-01 |