| NPI | 1356619910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 080817) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: NY 076402-1) |
| Enumeration Date | 2011-12-09 |
| Last Update Date | 2022-10-11 |