| NPI | 1477947091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 085766-01) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 091187) |
| Enumeration Date | 2015-03-20 |
| Last Update Date | 2022-11-01 |