| NPI | 1922573385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 088472-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 087553) |
| Enumeration Date | 2018-10-11 |
| Last Update Date | 2019-10-07 |