| NPI | 1457767303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 90144) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2014-07-10 |
| Last Update Date | 2025-09-11 |