| NPI | 1508626615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW137037) |
| Additional Taxonomies | 104100000X Social Worker (Licence: HI LSW-2908) |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2026-07-13 |