| NPI | 1487071320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 076200) |
| Additional Taxonomies | 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) (Licence: NY 090501) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2023-02-05 |