| NPI | 1104981083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R042880-1) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY R42880) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2010-03-03 |