| NPI | 1013230226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R057230-1) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 032500-1) |
| Enumeration Date | 2010-03-03 |
| Last Update Date | 2017-05-05 |