| NPI | 1821253295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 079391) |
| Enumeration Date | 2008-07-24 |
| Last Update Date | 2019-07-24 |