| NPI | 1285453894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 128926) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2024-10-09 |
| Last Update Date | 2026-06-22 |