| NPI | 1689616807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW81005) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R055756-1) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2023-12-04 |