| NPI | 1023498896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087906-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MN 28020) |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2019-06-14 |