| NPI | 1366688228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 077525) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 083277) |
| Enumeration Date | 2008-12-24 |
| Last Update Date | 2020-08-21 |