| NPI | 1518141415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 034600-1R) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NJ 44SC05214500) |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2007-12-27 |