| NPI | 1942663828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 11096) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 097064) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2020-10-14 |