| NPI | 1740332311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 055502) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NJ 44SC05156600) |
| 1041C0700X Social Worker, Clinical (Licence: FL SW6963) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2007-07-08 |