| NPI | 1912228552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 081198) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 122686) |
| 1041C0700X Social Worker, Clinical (Licence: PA CW023309) | |
| 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05949000) | |
| 1041C0700X Social Worker, Clinical (Licence: CA 63888) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2023-08-02 |