| NPI | 1124251640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 077159-1) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY P72709) |
| Enumeration Date | 2009-09-01 |
| Last Update Date | 2014-04-30 |