| NPI | 1255713129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 096306-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY P97553) |
| Enumeration Date | 2015-06-26 |
| Last Update Date | 2015-10-26 |