| NPI | 1134436090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 078482) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 077060-J) |
| Enumeration Date | 2010-09-13 |
| Last Update Date | 2011-09-06 |