| NPI | 1104477413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: DC LC200002621) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 094773) |
| 104100000X Social Worker (Licence: NY 107605) | |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2025-09-23 |