| NPI | 1467661397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 075877) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 111307) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2007-08-29 |