| NPI | 1538262787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R0431291) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC00676100) |
| 1223G0001X Dentist, General Practice (Licence: NY 032976-1) | |
| 1223G0001X Dentist, General Practice (Licence: NJ 22DI01134300) | |
| Enumeration Date | 2006-09-06 |
| Last Update Date | 2010-08-16 |