| NPI | 1548542483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083465) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 0842191) |
| 1041C0700X Social Worker, Clinical (Licence: NY 9016602) | |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2022-06-15 |