| NPI | 1871802132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 083873) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CA 110696) |
| Enumeration Date | 2010-10-04 |
| Last Update Date | 2023-07-18 |