| NPI | 1114910858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY PR025258) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC00126500) |
| 1041C0700X Social Worker, Clinical (Licence: MA 107681) | |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2008-02-26 |