| NPI | 1588192074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: WA 70000678) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: CA 98872) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2025-06-17 |