| NPI | 1255601969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 73 084286) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 72-084593) |
| Enumeration Date | 2012-01-11 |
| Last Update Date | 2024-01-12 |