| NPI | 1689900763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 095064-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 29116) |
| Enumeration Date | 2009-10-26 |
| Last Update Date | 2023-11-27 |