| NPI | 1912635293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904019375) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCSW128607) |
| Enumeration Date | 2022-08-12 |
| Last Update Date | 2026-01-20 |