| NPI | 1528428000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 085997) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 091065-1) |
| Enumeration Date | 2016-02-26 |
| Last Update Date | 2020-09-27 |