| NPI | 1730845090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 101970) |
| Additional Taxonomies | 1041S0200X Social Worker, School |
| 104100000X Social Worker | |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2026-02-10 |