| NPI | 1982981122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R082591) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 082591) |
| Enumeration Date | 2011-11-15 |
| Last Update Date | 2020-11-13 |