| NPI | 1710154737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 078011) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 071255) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2010-11-02 |