| NPI | 1518181635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MD 17745) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 069265) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2014-06-09 |