| NPI | 1598824021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C005841) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 052205) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2015-04-14 |