| NPI | 1649370651 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY R078455-01) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 073912) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2023-09-01 |