| NPI | 1093219636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087887) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 096317) |
| Enumeration Date | 2018-03-20 |
| Last Update Date | 2022-02-17 |