| NPI | 1316452014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C0171130) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 096341) |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2026-05-22 |