| NPI | 1427527068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 090707) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR L12496) |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2024-12-20 |