| NPI | 1760954259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 66066303501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: UT 6606630-3501) |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC06134500) | |
| 1041C0700X Social Worker, Clinical (Licence: NY 091469-01) | |
| Enumeration Date | 2018-12-20 |
| Last Update Date | 2022-12-19 |