| NPI | 1114084993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 000895) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY PR015818-1) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2007-07-08 |