| NPI | 1518415025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 111501) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW78382) |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2023-01-03 |