| NPI | 1083937536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: DE Q1-0001056) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 077738-1) |
| Enumeration Date | 2010-03-11 |
| Last Update Date | 2011-04-25 |