| NPI | 1073867313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 084455) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 079127) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2016-07-03 |