| NPI | 1437752912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 127877) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 97765) |
| Enumeration Date | 2020-11-18 |
| Last Update Date | 2025-04-23 |