| NPI | 1023323557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 081187) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 081845) |
| 1041C0700X Social Worker, Clinical (Licence: NE 2430) | |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2020-11-02 |