| NPI | 1073659298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: L5441) |
| Additional Taxonomies | 104100000X Social Worker (Licence: OR L5441) |
| 1041C0700X Social Worker, Clinical (Licence: NY 075642) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2020-03-24 |