| NPI | 1881013423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 72091303) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 090645) |
| Enumeration Date | 2014-04-10 |
| Last Update Date | 2021-03-02 |