| NPI | 1255759809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R072938) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 72938) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2023-05-15 |