| NPI | 1326734567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 095030) |
| 1041C0700X Social Worker, Clinical (Licence: CT 12887) | |
| Enumeration Date | 2023-04-12 |
| Last Update Date | 2023-04-12 |