| NPI | 1326257874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 080326-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MA 266406) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2013-02-28 |