| NPI | 1063029825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 045434) |
| Additional Taxonomies | 104100000X Social Worker |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2020-09-25 |
| Last Update Date | 2020-09-25 |