| NPI | 1386895993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY r0436731) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: NY r0436731) |
| Enumeration Date | 2008-10-02 |
| Last Update Date | 2008-10-02 |