| NPI | 1255053716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 117211) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 117211) |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2025-03-10 |