| NPI | 1902294770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 121415) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 101884) |
| Enumeration Date | 2015-01-02 |
| Last Update Date | 2025-04-17 |