| NPI | 1114231214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 069753-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NM I-07378) |
| Enumeration Date | 2010-07-30 |
| Last Update Date | 2022-04-06 |