| NPI | 1144203670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 076617-1) |
| Additional Taxonomies | 104100000X Social Worker (Licence: PA SW013673L) |
| 103TS0200X Psychologist, School (Licence: NY 1205995) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2010-12-05 |