| NPI | 1356431134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 077842) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 076559) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2013-12-04 |