| NPI | 1598996217 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: CT 009221) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY R22230) |
| Enumeration Date | 2009-07-29 |
| Last Update Date | 2025-08-18 |