| NPI | 1417680356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 117409) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 117409) |
| Enumeration Date | 2022-07-07 |
| Last Update Date | 2024-12-10 |