| NPI | 1851840813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 092200-01) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2016-09-30 |
| Last Update Date | 2022-09-27 |