| NPI | 1710128632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 12923) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 006154) |
| 1041C0700X Social Worker, Clinical (Licence: NY 073180) | |
| Enumeration Date | 2009-03-23 |
| Last Update Date | 2016-05-27 |