| NPI | 1770825705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 078475) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 078475-1) |
| Enumeration Date | 2013-03-16 |
| Last Update Date | 2022-10-03 |