| NPI | 1760843486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker Clinical (Licence: NC C012646) |
| Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: NY 088671) |
| Enumeration Date | 2016-03-08 |
| Last Update Date | 2024-04-17 |