| NPI | 1164507349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 63566) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 075802) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2023-08-21 |