| NPI | 1780295857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA 104471) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 263413) |
| Enumeration Date | 2020-08-12 |
| Last Update Date | 2023-06-28 |