| NPI | 1760204531 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: MO 2024043290) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NY 130727-01) |
| Enumeration Date | 2024-10-31 |
| Last Update Date | 2026-07-17 |