| NPI | 1700061348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: FL SW 9687) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY R054144-1) |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2010-07-28 |