| NPI | 1154649036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 076701) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 008474) |
| 1041C0700X Social Worker, Clinical (Licence: NY 081686) | |
| 1041C0700X Social Worker, Clinical (Licence: MA 121752) | |
| 183500000X Pharmacist (Licence: NY 045716) | |
| Enumeration Date | 2010-05-17 |
| Last Update Date | 2023-10-07 |