| NPI | 1629160304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R037061-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: TX 105214) |
| 1041C0700X Social Worker, Clinical (Licence: DE QL-0011916) | |
| 1041C0700X Social Worker, Clinical (Licence: CT 11464) | |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06012900) | |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2021-08-04 |