| NPI | 1023162971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY PRo25164-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC00015300) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2007-07-08 |