| NPI | 1487647178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 054696-R) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 11832) |
| 1041C0700X Social Worker, Clinical (Licence: MA 105983) | |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2015-04-15 |