| NPI | 1154684967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 084850) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 085943-1) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2019-01-07 |