| NPI | 1821915919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW82724) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC11795) |
| Enumeration Date | 2026-06-30 |
| Last Update Date | 2026-06-30 |