| NPI | 1376788497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 079795) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 0783791) |
| Enumeration Date | 2008-12-03 |
| Last Update Date | 2014-01-31 |