NPI | 1669738498 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 088127) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 085930-1) |
Enumeration Date | 2012-04-05 |
Last Update Date | 2020-03-12 |