| NPI | 1598190951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 81770LCSW) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 81770) |
| Enumeration Date | 2013-09-04 |
| Last Update Date | 2026-04-03 |