| NPI | 1306049150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 096818) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA 6157) |
| 1041C0700X Social Worker, Clinical (Licence: MS 9560) | |
| Enumeration Date | 2007-06-08 |
| Last Update Date | 2024-06-11 |