| NPI | 1629164991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCS21363) |
| Additional Taxonomies | 104100000X Social Worker (Licence: VA 0904015437) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2026-02-25 |