| NPI | 1366593303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 004238) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 079827) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2021-12-17 |