| NPI | 1649863879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: NY 109210) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NY 109210) |
| Enumeration Date | 2021-02-18 |
| Last Update Date | 2021-02-24 |