| NPI | 1386936565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083617) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 080498) |
| Enumeration Date | 2011-05-06 |
| Last Update Date | 2015-03-24 |