| NPI | 1326566571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041S0200X Social Worker, School (Licence: NY 101914) |
| Additional Taxonomies | 1041S0200X Social Worker, School |
| 1041C0700X Social Worker, Clinical (Licence: NY 101914) | |
| Enumeration Date | 2017-09-07 |
| Last Update Date | 2022-01-04 |