| NPI | 1740506658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083249) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 080921) |
| Enumeration Date | 2010-04-16 |
| Last Update Date | 2015-07-31 |