| NPI | 1922668508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 101YM0800X Counselor, Mental Health (Licence: CA 103366) | |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2025-03-19 |