| NPI | 1134437171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 044369) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: VT 089.0135680) |
| 1041S0200X Social Worker, School (Licence: NY 044369) | |
| Enumeration Date | 2010-09-23 |
| Last Update Date | 2024-01-05 |