| NPI | 1760696256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C010825) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 074242-1) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2020-11-02 |