| NPI | 1871126466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 116020) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA LICSW1142409) |
| Enumeration Date | 2020-02-21 |
| Last Update Date | 2026-03-12 |