| NPI | 1386969038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 077458-R) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 052319-1) |
| Enumeration Date | 2010-04-06 |
| Last Update Date | 2018-02-22 |