| NPI | 1659749224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L15610) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL 12267) |
| 1041C0700X Social Worker, Clinical (Licence: CA 81356) | |
| Enumeration Date | 2015-09-12 |
| Last Update Date | 2026-05-27 |