| NPI | 1538545553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087301) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 094892) |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2023-12-08 |