| NPI | 1467727412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 085486) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 085323-1) |
| Enumeration Date | 2012-03-08 |
| Last Update Date | 2017-07-14 |