| NPI | 1275005829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 012345) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 101692) |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2024-01-11 |