| NPI | 1235866062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 070436-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 0802957) |
| Enumeration Date | 2022-08-02 |
| Last Update Date | 2022-11-12 |