| NPI | 1912782889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA asw-132630) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-08-29 |
| Last Update Date | 2025-08-08 |