| NPI | 1023458841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 086097) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 092281-1) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2022-12-01 |