| NPI | 1487024113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 098970) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 68638) |
| Enumeration Date | 2015-10-07 |
| Last Update Date | 2024-09-11 |