| NPI | 1598039281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 84632) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 7113) |
| Enumeration Date | 2012-02-28 |
| Last Update Date | 2026-01-05 |