| NPI | 1225586985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 091387) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 099141) |
| Enumeration Date | 2016-09-12 |
| Last Update Date | 2021-12-17 |