| NPI | 1437148376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 002238) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CT 002238) |
| 101YM0800X Counselor, Mental Health (Licence: NY R067134-1) | |
| 1041C0700X Social Worker, Clinical (Licence: NY R0671341) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2024-02-13 |