| NPI | 1619178704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 21395) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS 21395) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2025-04-17 |