| NPI | 1578819447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 082884-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 088032-1) |
| Enumeration Date | 2012-07-30 |
| Last Update Date | 2019-08-02 |