| NPI | 1609711720 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 130813) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 34616) |
| Enumeration Date | 2026-04-23 |
| Last Update Date | 2026-04-23 |