| NPI | 1821287913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087102) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 10469) |
| 104100000X Social Worker | |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2019-02-28 |