| NPI | 1174979363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 095247-01) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 097482-1) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2023-04-27 |