| NPI | 1649863879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 099328) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 109210) |
| 104100000X Social Worker (Licence: NY 109210) | |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2025-02-19 |