| NPI | 1639400930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 104100000X Social Worker (Licence: CA 105638) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 105638) | |
| Enumeration Date | 2010-01-26 |
| Last Update Date | 2023-04-26 |