| NPI | 1265081582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 091850-01) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 10031-0000) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2024-02-06 |