| NPI | 1366860066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 73-083636) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: NY 084847-1) |
| Enumeration Date | 2014-03-31 |
| Last Update Date | 2020-02-19 |