| NPI | 1740626936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 085215) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 086839) |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2021-02-03 |