| NPI | 1750983748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 090598-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 102325-01) |
| Enumeration Date | 2020-11-13 |
| Last Update Date | 2021-01-13 |