| NPI | 1487800538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 079045) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY P66325) |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2020-04-20 |