| NPI | 1245243575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R070801-1) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 070801-1) |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2013-03-14 |