| NPI | 1649387150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 012554) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 069832-1) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2023-03-07 |