| NPI | 1609727411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW108005) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI CSW04418) |
| Enumeration Date | 2026-02-06 |
| Last Update Date | 2026-05-21 |