| NPI | 1750832739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: 089032) |
| Additional Taxonomies | 104100000X Social Worker (Licence: NY 098655) |
| Enumeration Date | 2016-10-14 |
| Last Update Date | 2020-09-17 |