| NPI | 1356409635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: SC 9967) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 070514-1) |
| 1041C0700X Social Worker Clinical (Licence: NC C006576) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2014-06-09 |