| NPI | 1083465264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 101271) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA 116209) |
| Enumeration Date | 2024-03-27 |
| Last Update Date | 2026-06-11 |