| NPI | 1508460916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 097944) |
| Enumeration Date | 2020-11-25 |
| Last Update Date | 2024-07-11 |