| NPI | 1396197851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 72512) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 082240) |
| Enumeration Date | 2016-07-08 |
| Last Update Date | 2017-03-10 |