| NPI | 1811324130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW101697) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 1041C0700X Social Worker, Clinical (Licence: NY 100552) | |
| 101Y00000X Counselor (Licence: CA ASW83533) | |
| Enumeration Date | 2013-10-01 |
| Last Update Date | 2025-10-14 |