| NPI | 1235455874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R057519) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R057519-1) |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2013-09-24 |