| NPI | 1891253613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 112718) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2024-07-04 |