| NPI | 1578985289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 103532) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2024-01-31 |