| NPI | 1720382526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO 1744) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 19941) |
| Enumeration Date | 2011-01-07 |
| Last Update Date | 2026-09-06 |