| NPI | 1790835080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 082418-1) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 051439) |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2014-10-06 |