| NPI | 1649463324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 055640) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CT 005495) |
| Enumeration Date | 2007-08-24 |
| Last Update Date | 2007-08-24 |