| NPI | 1598018038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 084470) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 078950) |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2023-04-25 |