| NPI | 1497323539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 100005) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA ASW100005) |
| 1041C0700X Social Worker Clinical (Licence: CA 100005) | |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2024-01-26 |