| NPI | 1720540412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 106496) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 83303) |
| Enumeration Date | 2019-04-02 |
| Last Update Date | 2022-05-07 |