| NPI | 1730373622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 074942) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 078568) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2011-08-16 |