| NPI | 1366965162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087362-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 095348) |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2019-11-07 |