| NPI | 1912048190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904007185) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R0274821) |
| 1041C0700X Social Worker, Clinical (Licence: NY R027482-1) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2014-10-14 |