| NPI | 1700174992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 079419-1) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 076771-1) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2020-01-24 |