| NPI | 1992568034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 121694) |
| Additional Taxonomies | 104100000X Social Worker (Licence: TX 109616) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2024-02-01 |
| Last Update Date | 2026-05-27 |