| NPI | 1841345741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083365) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 075232) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2015-09-01 |