| NPI | 1457123341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 127518) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904019089) |
| Enumeration Date | 2023-10-24 |
| Last Update Date | 2026-04-27 |