| NPI | 1730564659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 089868) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 088073) |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2019-08-21 |