| NPI | 1013396233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087863) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2019-04-27 |