| NPI | 1306366182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 106859) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VA 0904019034) |
| 1041C0700X Social Worker, Clinical (Licence: NV 12697-C) | |
| 1041C0700X Social Worker, Clinical (Licence: CT 016507) | |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2026-05-15 |