| NPI | 1699003392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 052154) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R052154-1) |
| Enumeration Date | 2009-11-18 |
| Last Update Date | 2024-05-15 |