| NPI | 1316921554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R042315-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: RI ISW01144) |
| 1041C0700X Social Worker, Clinical (Licence: MA LICSW126181) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2025-06-13 |