| NPI | 1720509201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 21436) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 21436) |
| Enumeration Date | 2017-07-05 |
| Last Update Date | 2017-07-05 |