| NPI | 1013979897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 057740) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 057740) |
| 1041S0200X Social Worker, School (Licence: NY 057740) | |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2020-08-25 |