| NPI | 1265916902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 092469) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 103802-1) |
| Enumeration Date | 2018-09-19 |
| Last Update Date | 2022-01-21 |