| NPI | 1962837088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 124022) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 086625) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2025-01-08 |