| NPI | 1639698376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 092972) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 104287) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2022-06-30 |