| NPI | 1184947319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 080057) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 72 078577) |
| Enumeration Date | 2010-03-02 |
| Last Update Date | 2015-02-20 |