| NPI | 1790200905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA ASW89724) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW89724) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2023-07-31 |