| NPI | 1306911284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R031822-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 011044) |
| Enumeration Date | 2006-11-23 |
| Last Update Date | 2023-07-05 |