| NPI | 1750431045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 071740) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C005966) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2021-04-15 |