| NPI | 1306120530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 083728-1) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 104100000X Social Worker (Licence: NY 082205-1) | |
| Enumeration Date | 2011-10-06 |
| Last Update Date | 2023-12-08 |