| NPI | 1952912883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 094293-01) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2020-08-13 |
| Last Update Date | 2023-01-10 |