| NPI | 1487830170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 079921) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 75294) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2017-04-11 |