| NPI | 1417152513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R-030207) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C005238) |
| 1041C0700X Social Worker, Clinical (Licence: DE Q1-001299) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2024-05-14 |