| NPI | 1366643470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 054289) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44sc05232500) |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2007-07-08 |