| NPI | 1730446113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 141510) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101Y00000X Counselor (Licence: CA 108972) | |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2026-08-18 |