NPI | 1689341356 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 100824) |
Additional Taxonomies | 104100000X Social Worker (Licence: NY 113539) |
Enumeration Date | 2021-08-30 |
Last Update Date | 2025-08-25 |