| NPI | 1164453304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW7852) |
| Additional Taxonomies | 171W00000X Contractor (Licence: NY R54325-1) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2008-09-30 |