| NPI | 1457981102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 094415-01) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 104619) |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2023-03-07 |