| NPI | 1518702976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L18555) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR A15334) |
| 1041C0700X Social Worker, Clinical (Licence: OR 24-QMHP-R-2920) | |
| Enumeration Date | 2024-06-27 |
| Last Update Date | 2026-08-10 |