| NPI | 1023451069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 83253) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 079270-1) |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2024-05-10 |