| NPI | 1467850263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 082629-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 084939-1) |
| Enumeration Date | 2014-12-09 |
| Last Update Date | 2015-03-24 |