| NPI | 1407091770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 093355) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 078157-1) |
| Enumeration Date | 2008-12-15 |
| Last Update Date | 2022-05-10 |