| NPI | 1699179101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 091092-01) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 093348) |
| Enumeration Date | 2014-10-13 |
| Last Update Date | 2021-03-24 |