| NPI | 1992432041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW125894) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC23722) |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2025-12-07 |