| NPI | 1134409444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 26303) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY P81553) |
| 1041C0700X Social Worker, Clinical (Licence: MD 23603) | |
| Enumeration Date | 2011-08-18 |
| Last Update Date | 2023-10-24 |