| NPI | 1164056057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 086159) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: FL SW10685) |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2023-05-15 |