| NPI | 1861048928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 109696) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 91313) |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2026-08-17 |