| NPI | 1457026684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 130391) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ACSW109671) |
| Enumeration Date | 2021-08-10 |
| Last Update Date | 2025-06-23 |