| NPI | 1093010365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW79970) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 116322) |
| 1041C0700X Social Worker, Clinical (Licence: CO CSW.0009930423) | |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2026-04-09 |