| NPI | 1669947966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW97882) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA ASW75667) |
| Enumeration Date | 2018-10-12 |
| Last Update Date | 2025-07-30 |