| NPI | 1205275047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 73 084674) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2016-09-01 |