| NPI | 1508113861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 084011) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 086705) |
| Enumeration Date | 2012-08-06 |
| Last Update Date | 2016-09-03 |