| NPI | 1326493826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 092138) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 098801) |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2021-10-12 |