| NPI | 1770667511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 070632-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 070632) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2018-01-24 |