| NPI | 1265748610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 100412) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 085582) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2021-03-10 |