| NPI | 1740560937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 73620) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW73620) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2025-07-24 |