| NPI | 1720575731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 094012) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 097018-1) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2025-08-29 |