| NPI | 1326234840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: 44SC05391600) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 058247-1) |
| Enumeration Date | 2007-09-18 |
| Last Update Date | 2022-07-21 |