| NPI | 1871847830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 083871-R) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 083871-1) |
| 1041C0700X Social Worker, Clinical (Licence: NY 086954-1) | |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2021-01-25 |