| NPI | 1952531105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 080418-1) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 078291-1) |
| Enumeration Date | 2009-07-22 |
| Last Update Date | 2013-10-21 |