| NPI | 1770948341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TN 6603) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 083787-1) |
| Enumeration Date | 2015-12-23 |
| Last Update Date | 2022-07-21 |