| NPI | 1942675343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 090960) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 086304) |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2018-07-18 |