| 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 |