| NPI | 1013466366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 086539) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 090124) |
| Enumeration Date | 2016-09-28 |
| Last Update Date | 2018-06-19 |