| NPI | 1861183147 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 104100000X Social Worker (Licence: CA ASW129402)  | 
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator | 
| Enumeration Date | 2023-05-17 | 
| Last Update Date | 2025-03-31 |