| NPI | 1306934898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 072694) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 056018) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2011-11-02 |