| NPI | 1255165452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 014296) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 081286-1) |
| Enumeration Date | 2024-08-29 |
| Last Update Date | 2024-08-29 |