| NPI | 1891126470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 084940) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 089552) |
| Enumeration Date | 2013-12-06 |
| Last Update Date | 2016-11-22 |