| NPI | 1659596021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R077765) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 072674-1) |
| 1041C0700X Social Worker, Clinical (Licence: NY 077765) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2013-12-09 |