| NPI | 1245517895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 082400) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 080335) |
| 1041C0700X Social Worker, Clinical (Licence: CA 93051) | |
| Enumeration Date | 2011-11-10 |
| Last Update Date | 2020-02-05 |