| NPI | 1861608101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 005288) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 040900-1) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2023-06-26 |