| NPI | 1457626020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 078246) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: NY 21320600) |
| Enumeration Date | 2012-03-15 |
| Last Update Date | 2022-07-28 |