| NPI | 1487180741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 088382) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 090775-1) |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2019-06-25 |