| NPI | 1154750099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 087250) |
| Additional Taxonomies | 1041S0200X Social Worker School (Licence: NY 090157) |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2019-08-08 |