| NPI | 1568062875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 090625) |
| Additional Taxonomies | 251S00000X (Licence: NY 101934) |
| Enumeration Date | 2020-10-27 |
| Last Update Date | 2020-12-28 |