| NPI | 1285120832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 092901) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 103824) |
| 1041C0700X Social Worker, Clinical (Licence: NY 103824) | |
| Enumeration Date | 2018-07-06 |
| Last Update Date | 2023-03-01 |