| NPI | 1932596517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 50.008921) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 083643) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2022-11-16 |