NPI | 1619061322 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 113892) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R-039917-1) |
Enumeration Date | 2006-10-03 |
Last Update Date | 2011-10-16 |