| NPI | 1649589714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 081545) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 079067-1) |
| Enumeration Date | 2010-10-06 |
| Last Update Date | 2014-09-12 |