| NPI | 1679923395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: 088836-01) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 097559) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2021-06-27 |