| NPI | 1447697909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 80638) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L14272) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2026-02-10 |