| NPI | 1659697837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 081535) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 079715) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2014-02-04 |