| NPI | 1053569079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05999200) |
| 1041C0700X Social Worker, Clinical (Licence: NY 087578) | |
| 1041C0700X Social Worker, Clinical (Licence: MA 121590) | |
| 1041C0700X Social Worker, Clinical (Licence: IL 149.014343) | |
| 1041C0700X Social Worker, Clinical (Licence: IL 149014343) | |
| 1041C0700X Social Worker, Clinical (Licence: WA 60513696) | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2021-10-06 |