| NPI | 1962971085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR A15256) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW102125) |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2024-06-06 |