| NPI | 1194835272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY PR019400-1) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY PR0194001) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-01-20 |