| NPI | 1205174471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 084015) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 088116) |
| 1041C0700X Social Worker, Clinical (Licence: 084015) | |
| Enumeration Date | 2013-01-23 |
| Last Update Date | 2020-09-28 |