| NPI | 1023174992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R003054-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW827) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2007-07-09 |