| NPI | 1821133554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R052675-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 052675) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2018-12-27 |