| NPI | 1568092211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 108030) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 098661) |
| Enumeration Date | 2020-01-22 |
| Last Update Date | 2024-12-16 |