| NPI | 1275765257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083360) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 078782) |
| Enumeration Date | 2009-08-10 |
| Last Update Date | 2016-03-21 |