| NPI | 1386066637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 055375) |
| Additional Taxonomies | 251S00000X (Licence: NY 055375) |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2014-01-06 |