| NPI | 1174699532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: R014105-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY r14105) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2022-03-19 |