| NPI | 1851773329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087070) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 094329-1) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2018-07-13 |