NPI | 1760872113 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083146-1) |
Additional Taxonomies | 104100000X Social Worker (Licence: NY 083805-1) |
Enumeration Date | 2015-01-23 |
Last Update Date | 2015-05-22 |