| NPI | 1730853847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 091150) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 097409) |
| 1041C0700X Social Worker, Clinical | |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2021-08-09 |