| NPI | 1962529727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 5705213) |
| Additional Taxonomies | 1041S0200X Social Worker School |
| Enumeration Date | 2007-03-24 |
| Last Update Date | 2011-05-24 |