| NPI | 1831268747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 105874) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R035681-1) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2012-06-26 |