| NPI | 1952611501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 078686) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IN 34006106A) |
| Enumeration Date | 2010-10-18 |
| Last Update Date | 2011-06-15 |