| NPI | 1639696628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 087600) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 096032) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2018-11-14 |