| NPI | 1306415047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 093667) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CT 012358) |
| Enumeration Date | 2021-06-17 |
| Last Update Date | 2022-10-19 |