NPI | 1164035200 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 093837-01) |
Additional Taxonomies | 104100000X Social Worker (Licence: NY 101668-01) |
Enumeration Date | 2020-08-28 |
Last Update Date | 2023-10-01 |