| NPI | 1265103683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 099619) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 114108) |
| Enumeration Date | 2021-09-24 |
| Last Update Date | 2025-03-19 |