| NPI | 1568988715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 093134-01) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 104787-1) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-08-19 |
| Last Update Date | 2022-04-05 |