| NPI | 1740373828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 130250) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OK 3606) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2025-08-16 |