| NPI | 1255778213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087679) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 087847) |
| Enumeration Date | 2013-05-31 |
| Last Update Date | 2019-01-26 |