| NPI | 1225329386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R044229-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY Ro44229-1) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2022-07-21 |