| NPI | 1447533302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087840-1) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: NY 071243) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2021-08-02 |