| NPI | 1184633588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 076976) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 007257) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2013-08-09 |