| NPI | 1972798130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 730078404) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 070816) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2018-12-20 |