| NPI | 1225206170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: UT 6597778-3502) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 073336) |
| Enumeration Date | 2008-02-13 |
| Last Update Date | 2008-02-13 |