| 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 |