| NPI | 1396389946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 101703) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MD 28136) |
| Enumeration Date | 2019-11-06 |
| Last Update Date | 2025-12-10 |