| NPI | 1619455656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 108354) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW133735) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2022-09-27 |