| NPI | 1891474524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker School |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker Clinical (Licence: CA 115316) | |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2024-11-19 |