| NPI | 1184284333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 091105) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 094785) |
| Enumeration Date | 2019-06-19 |
| Last Update Date | 2021-03-17 |