| NPI | 1801056932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 13757) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 101160) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2026-02-11 |