| NPI | 1861753857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA LCSW87679) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 083416) |
| Enumeration Date | 2012-06-06 |
| Last Update Date | 2022-07-25 |