| NPI | 1740326180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ 16414) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 66078) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2025-06-16 |