| NPI | 1215261912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 080291) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY P72324) |
| Enumeration Date | 2009-09-28 |
| Last Update Date | 2019-10-01 |