| NPI | 1134334188 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY R068622) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PA CWO12697) |
| Enumeration Date | 2007-05-13 |
| Last Update Date | 2007-07-08 |