| NPI | 1588259642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 253J00000X Foster Care Agency |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2026-09-10 |