| NPI | 1366712507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 87678) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 085755) |
| Enumeration Date | 2012-01-05 |
| Last Update Date | 2024-03-14 |