| NPI | 1225045511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 049123R) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY R049123) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-03-08 |