| NPI | 1447793674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 090229) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 098986-1) |
| Enumeration Date | 2016-11-20 |
| Last Update Date | 2022-05-20 |