| NPI | 1699064147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 78559) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TN 6625) |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2026-03-04 |