| NPI | 1750604856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AZ 15397) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 075220) |
| Enumeration Date | 2010-03-04 |
| Last Update Date | 2016-05-19 |