| NPI | 1326812355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL 4295) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 94405) |
| Enumeration Date | 2023-11-09 |
| Last Update Date | 2023-11-09 |