| NPI | 1841849817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY PR0218371) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY PR0218371) |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2019-09-11 |