| NPI | 1760033575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW122304) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WA SC61314079) |
| Enumeration Date | 2019-09-23 |
| Last Update Date | 2024-07-10 |