| NPI | 1083196455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 095382) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 106822-01) |
| Enumeration Date | 2018-09-03 |
| Last Update Date | 2023-09-14 |