| NPI | 1972656254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 077664) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 26723) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2011-01-21 |