| NPI | 1992988786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 0792071) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 079207) |
| Enumeration Date | 2007-12-14 |
| Last Update Date | 2020-11-18 |