| NPI | 1730336546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 101284) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 24004) |
| 1041C0700X Social Worker, Clinical (Licence: CA 63163) | |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2025-08-06 |