| NPI | 1669125852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 096970) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 113614) |
| Enumeration Date | 2022-01-28 |
| Last Update Date | 2024-02-15 |