| NPI | 1578669495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R.035856-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R0358561) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2023-10-12 |