| NPI | 1164918561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 093362) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 102393) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2018-07-09 |
| Last Update Date | 2025-01-20 |