| NPI | 1710224209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 085321) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 081173) |
| Enumeration Date | 2013-01-03 |
| Last Update Date | 2017-03-28 |