| NPI | 1649726993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 109190) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 109190) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2025-06-13 |