| NPI | 1295340156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L11258) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: OR 553664) |
| 1041S0200X Social Worker, School (Licence: CA 200135836) | |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2025-03-02 |