| NPI | 1043455710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 73 076450) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC0534600) |
| Enumeration Date | 2008-12-10 |
| Last Update Date | 2008-12-10 |