| NPI | 1366809709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 1626558) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: PA 220460683) |
| Enumeration Date | 2016-01-15 |
| Last Update Date | 2023-06-05 |