| NPI | 1114295029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C016004) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 101011) |
| Enumeration Date | 2011-12-06 |
| Last Update Date | 2025-10-29 |