| NPI | 1083374557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 099799) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 108113) |
| Enumeration Date | 2021-12-27 |
| Last Update Date | 2025-03-17 |