| NPI | 1437585445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087736) |
| Additional Taxonomies | 101Y00000X Counselor |
| 104100000X Social Worker (Licence: NY 092611) | |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2020-12-28 |