| NPI | 1366841140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 100442) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 126713) |
| Enumeration Date | 2014-08-18 |
| Last Update Date | 2026-03-31 |