| NPI | 1326369257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 078941) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH I.2102567-SUPV) |
| 1041C0700X Social Worker, Clinical (Licence: MA 115618) | |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2025-04-24 |