| NPI | 1033305354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 07373) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 073073) |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2020-04-20 |