| NPI | 1215211388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083253-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 084202) |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2018-05-28 |