| NPI | 1699363705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: AK 234951) |
| Additional Taxonomies | 104100000X Social Worker (Licence: AK 225830) |
| 104100000X Social Worker (Licence: NY 097549) | |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2025-06-02 |