| NPI | 1063820165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 086244) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY P93378) |
| 104100000X Social Worker (Licence: NY 093797) | |
| Enumeration Date | 2014-08-01 |
| Last Update Date | 2018-03-17 |