| NPI | 1700324449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 089814) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 0889492) |
| Enumeration Date | 2017-02-02 |
| Last Update Date | 2021-12-09 |