| NPI | 1164699245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY RO31749) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 31749) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2021-01-18 |