| NPI | 1851459853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 078879) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 26193) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2022-09-26 |