| NPI | 1679247605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 127700) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 102349) |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2026-01-06 |