| NPI | 1508358508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: FL SW17358) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 102155) |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2023-03-22 |