| NPI | 1629444161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087828) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 0913871) |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2023-06-15 |