| NPI | 1598910671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY PR024462) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 012429) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2022-09-28 |