| NPI | 1497156939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087897) |
| Additional Taxonomies | 252Y00000X Early Intervention Provider Agency (Licence: NY 092670) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2019-09-23 |