| NPI | 1366960767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 093530) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 101296) |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2023-03-08 |