| NPI | 1184040933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: CA LCSW28423) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 28423) |
| Enumeration Date | 2014-03-17 |
| Last Update Date | 2025-06-13 |