| NPI | 1255382289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW7810) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY PR028289-1) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2007-07-08 |