| NPI | 1477800621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083801) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 086979-1) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2015-11-23 |