| NPI | 1306529086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW141656) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 116172) |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2026-09-03 |