| NPI | 1265769517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 094836) |
| Additional Taxonomies | 104100000X Social Worker |
| 104100000X Social Worker (Licence: NY 091482) | |
| Enumeration Date | 2009-11-06 |
| Last Update Date | 2023-02-07 |