| NPI | 1508031436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: 077444-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 066767-1) |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2019-01-30 |