| NPI | 1205595352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: VA 0904016989) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 114741) |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2024-06-27 |