| NPI | 1740893007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NY 097302) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO CSW.09930914) |
| 104100000X Social Worker (Licence: NY 108084) | |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2024-09-18 |