| NPI | 1174146351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW91008) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 91008) |
| Enumeration Date | 2020-05-22 |
| Last Update Date | 2025-01-05 |