| NPI | 1235703992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 084710) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 112899) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2023-03-27 |