| NPI | 1205160405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0001143) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 079938) |
| 1041C0700X Social Worker, Clinical (Licence: NY 73 080121) | |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2013-02-20 |