| NPI | 1194109595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 090213-01) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 087041-1) |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2020-10-14 |