| NPI | 1255103222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: LA 18155) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 132701) |
| 104100000X Social Worker (Licence: NY 111089-01) | |
| 104100000X Social Worker (Licence: LA 18155) | |
| Enumeration Date | 2023-10-24 |
| Last Update Date | 2025-11-03 |