| NPI | 1336234368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 8071587) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY R0518961) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2013-02-01 |