| NPI | 1447348438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 055481-1) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: CT 001454) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |