| NPI | 1023235843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 075195) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NC 303272) |
| Enumeration Date | 2007-04-20 |
| Last Update Date | 2020-06-25 |