| NPI | 1720420490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083673) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 087508) |
| Enumeration Date | 2013-07-23 |
| Last Update Date | 2015-10-21 |