| NPI | 1568935294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 094798) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 104737-1) |
| Enumeration Date | 2019-01-04 |
| Last Update Date | 2023-01-26 |