| NPI | 1306918792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MA 111772) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY PR012213-1) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2007-07-08 |