| NPI | 1992932479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: OR L6016) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 069903-1) |
| 1041C0700X Social Worker, Clinical (Licence: NY 069903) | |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2014-09-22 |