| NPI | 1003095795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 089948) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 114361) |
| Enumeration Date | 2007-10-30 |
| Last Update Date | 2022-11-04 |