| NPI | 1932173721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY R0342291) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 0033081) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2007-07-08 |