| NPI | 1639260029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 077808) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 071421-1) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2010-11-09 |