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 |