| NPI | 1407191166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 080443) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 078824) |
| Enumeration Date | 2012-12-06 |
| Last Update Date | 2014-05-22 |