| NPI | 1013044148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 078053) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 073599-1) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2013-05-28 |