| NPI | 1508414111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 096675) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 109576) |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2024-01-21 |