| NPI | 1942590617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 73 078451) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 72 065504) |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2011-08-24 |