| NPI | 1891914446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R049009-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: HI LCSW-3029) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2007-07-19 |