| NPI | 1982965281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY R057653) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PR 9819) |
| Enumeration Date | 2012-06-04 |
| Last Update Date | 2012-06-04 |