| NPI | 1164018784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 094314) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 104808) |
| Enumeration Date | 2020-12-17 |
| Last Update Date | 2022-10-17 |