| NPI | 1629571195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QC1500X Clinic/Center Community Health (Licence: NY 098303) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 097276) |
| Enumeration Date | 2018-03-12 |
| Last Update Date | 2024-03-22 |