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 |