| NPI | 1346621240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: TN 8508) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 094954) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2024-06-05 |