| NPI | 1225331069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 079961-1) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 078148-1) |
| Enumeration Date | 2010-12-17 |
| Last Update Date | 2021-01-19 |