| NPI | 1932850807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OR A14285) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 24-QMHPC-001510) |
| 104100000X Social Worker (Licence: CA 113693) | |
| Enumeration Date | 2022-01-12 |
| Last Update Date | 2024-07-30 |