| NPI | 1568469807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R027769) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY R027769) |
| 1041S0200X Social Worker, School | |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2014-11-10 |