| NPI | 1912216714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 080775) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 083318-1) |
| Enumeration Date | 2010-09-28 |
| Last Update Date | 2013-11-22 |