| NPI | 1386665123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 24241) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 055394) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2015-08-31 |