| NPI | 1134407562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L7307) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW65037) |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2026-02-19 |