| NPI | 1609236405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 084181) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 009163) |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2016-04-21 |