| NPI | 1811229230 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DE Q1-0001071) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 042746-1) |
| Enumeration Date | 2010-02-10 |
| Last Update Date | 2011-03-22 |