| NPI | 1710425640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NY 092944) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: PA 020402) |
| Enumeration Date | 2017-02-11 |
| Last Update Date | 2022-07-27 |