| NPI | 1003074329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: GA csw002174) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY pro024609-1) |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2008-05-23 |