| NPI | 1295457208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 102329) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 117316) |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2022-09-15 |