| NPI | 1265578272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X (Licence: NY 073402-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 073402-1) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2008-06-24 |