| 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 |