| NPI | 1689891103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 081612) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA LCS 22468) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2014-11-13 |