| NPI | 1164992467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 191501) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 102571) |
| Enumeration Date | 2018-11-29 |
| Last Update Date | 2021-06-11 |