| NPI | 1245630235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 086690) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 72092804) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2018-05-21 |