| NPI | 1902552797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: CA 260141868) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW87589) |
| Enumeration Date | 2022-03-01 |
| Last Update Date | 2026-07-07 |