| NPI | 1992873756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 077662) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 077662R) |
| 1041S0200X Social Worker, School (Licence: NY 794944) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2021-10-23 |