| NPI | 1124436613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087471) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 092272) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2022-12-15 |