| NPI | 1003314626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN LCSW10650) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW138104) |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2026-09-11 |