| NPI | 1336387950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 079114) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 077639-1) |
| Enumeration Date | 2009-02-04 |
| Last Update Date | 2012-02-23 |