| NPI | 1073977229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 074334-1) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 74334-1) |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2023-09-27 |