| NPI | 1043383979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 082201-1) |
| Additional Taxonomies | 122300000X Dentist (Licence: NY 33559) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2023-01-09 |