| NPI | 1003523416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 093984-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: IL 149020512) |
| Enumeration Date | 2022-11-04 |
| Last Update Date | 2022-11-04 |