| NPI | 1821684523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 101858) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TN 11821) |
| Enumeration Date | 2020-12-16 |
| Last Update Date | 2024-12-18 |