| NPI | 1598302184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 09490901) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 10793801) |
| Enumeration Date | 2019-12-03 |
| Last Update Date | 2023-02-12 |