| NPI | 1285739508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 044588) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 075130) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2010-08-12 |