| NPI | 1235703992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 098542) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 112899) |
| 1041C0700X Social Worker Clinical (Licence: NY 084710) | |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2024-11-08 |