| NPI | 1629299664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 076729) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 650621) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2024-04-03 |