| NPI | 1164702064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083011) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 003020) |
| Enumeration Date | 2011-08-23 |
| Last Update Date | 2024-05-30 |