| NPI | 1144876723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 10694) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 091416) |
| Enumeration Date | 2019-08-10 |
| Last Update Date | 2021-07-12 |