NPI | 1619449634 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 09336) |
Additional Taxonomies | 101Y00000X Counselor (Licence: NY 104573) |
Enumeration Date | 2019-01-02 |
Last Update Date | 2022-05-01 |