| NPI | 1356753834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: MD 22112) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 096486) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2018-04-16 |