| NPI | 1255606133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 082831) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 081530) |
| 1041C0700X Social Worker Clinical | |
| Enumeration Date | 2012-03-12 |
| Last Update Date | 2021-12-02 |