| NPI | 1700417763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 091555) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 102633) |
| Enumeration Date | 2020-01-29 |
| Last Update Date | 2021-07-07 |