| NPI | 1083125181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 091076) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 101162) |
| Enumeration Date | 2017-10-16 |
| Last Update Date | 2021-05-04 |