| NPI | 1235670654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 091688) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: 091688) |
| Enumeration Date | 2017-03-17 |
| Last Update Date | 2021-10-07 |