| NPI | 1710431648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L13710) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 103743) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2025-02-04 |