| NPI | 1457697807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CA 76708) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 0851331) |
| Enumeration Date | 2012-12-12 |
| Last Update Date | 2022-07-21 |