| NPI | 1477942589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 132614) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: KY 253922) |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2025-12-01 |