| NPI | 1578801684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 081048) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 082796) |
| Enumeration Date | 2013-01-24 |
| Last Update Date | 2013-08-28 |