| NPI | 1801355540 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW342112) | 
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149.021058) | 
| Enumeration Date | 2019-03-12 | 
| Last Update Date | 2025-06-27 |