| NPI | 1629101233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C005586) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 075641) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2010-03-05 |