| NPI | 1336784156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 091085) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 100668) |
| Enumeration Date | 2019-11-15 |
| Last Update Date | 2022-06-28 |