| NPI | 1194098707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 079896) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05956600) |
| 1041C0700X Social Worker, Clinical (Licence: MI 6801113573) | |
| Enumeration Date | 2012-02-13 |
| Last Update Date | 2023-02-15 |