| NPI | 1063050052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 1821078932) |
| Additional Taxonomies | 104100000X Social Worker (Licence: RI ISW03149) |
| Enumeration Date | 2019-12-20 |
| Last Update Date | 2021-02-09 |