| NPI | 1538681978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 089842) |
| Additional Taxonomies | 1041S0200X Social Worker, School (Licence: NY 1070783161) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2021-10-14 |