| NPI | 1598223927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 092971-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 105930) |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2022-09-02 |