| NPI | 1417647041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 114948) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 12180123) |
| Enumeration Date | 2023-05-08 |
| Last Update Date | 2026-03-16 |