| NPI | 1306230982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 0887337) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 093926) |
| 164W00000X Licensed Practical Nurse (Licence: NY 275234-1) | |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2022-04-09 |