| NPI | 1538310420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 086931-1) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 083401-1) |
| Enumeration Date | 2008-10-09 |
| Last Update Date | 2018-12-31 |