| NPI | 1205024619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 007447) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 076177) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2024-04-01 |