| NPI | 1750394631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 076191-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 070078-1) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2014-01-06 |