| NPI | 1790124063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083681) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 086989-1) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2021-05-15 |