| NPI | 1821434291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 085187) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 088056-1) |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2017-02-01 |