| NPI | 1801156567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW76696) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 76696) |
| Enumeration Date | 2012-05-29 |
| Last Update Date | 2026-05-06 |