| NPI | 1174770143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CT 006916) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 077110) |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2010-12-02 |