| NPI | 1588128052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 091978) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 100903) |
| Enumeration Date | 2019-01-29 |
| Last Update Date | 2022-03-29 |